The purpose of this revised R21 is to test the feasibility, acceptability, and initial efficacy of a real-time video- based telemedicine interventon addressing parents' fear of hypoglycemia (FH) and parenting stress in families of young children with type 1 diabetes (T1DM). Hypoglycemia is a common negative event associated with intensive insulin therapy in children with T1DM and a significant barrier to optimal glycemic control. Young children are particularly vulnerable to episodes of severe hypoglycemia and their parents, who bear the primary responsibility for daily diabetes cares, report high rates of moderate to severe FH. FH leads to two problems: impaired quality of life and compensatory behaviors that raise blood glucose levels leading to increased risk for long-term vascular complications. There are no interventions that address FH and are specific to parents of young children with T1DM. By combining T1DM education, behavioral-parent training, and cognitive-behavior therapy, we are seeking to reduce FH and stress in parents and improve health outcomes for young children. The PI is a leader in studying T1DM management in young children and she is now focused on developing effective interventions to promote optimal health outcomes for young children. The revised R21 aims are: 1) determine feasibility and acceptability of a specific and targeted intervention to reduce parental FH and improve glycemic control and variability in young children with T1DM and 2) determine the initial efficacy of the intervention on parental FH and stress and children's glycemic levels and variability using a randomized, wait-list control design. Ultimately, 48 parents, recruited in 3 cohorts, will be randomly assigned to either the immediate treatment or wait-list control conditions to allow for iterative treatment refinement. The RED CHiP (Reducing Emotional Distress for Childhood Hypoglycemia in Parents) intervention will involve 10- sessions alternating between group and individual meetings delivered via real-time video-based telemedicine. Assessments will occur at baseline, post-treatment, and follow-up for immediate treatment parents and baseline, pre-treatment, and post-treatment for wait-list control parents. Primary outcome measures will be: parents' FH, stress, children's HbA1c, and children's glycemic variability. The revised R21 is significant because FH is common in parents of young children and related to poor T1DM self-care and higher blood glucose levels, which, in turn, relate to expensive and potentially devastating immediate and long-term complications. It is innovative in its focus on parental FH as a barrier to optimal child glycemic control, its plan to alternate between group and individual sessions to allow for both efficient treatment delivery and individual tailoring of the content, an its plan to use real-time video-based telemedicine to deliver the intervention. We expect the intervention pilot-tested in this revised R21 will have public health significance in reducing parental FH and stress and improving health outcomes for young children. We will also have data as to the feasibility and acceptability of using video-telemedicine to deliver a group-based behavioral intervention to parents.